| NPI | 1528703527 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUBY GODBOLT Owner 410-304-3232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology |
| Enumeration Date | 2022-05-03 |
| Last Update Date | 2022-05-04 |